Intralesional corticosteroid injection as a conservative treatment for central giant cell granuloma: a review of the literature

El granuloma central de células gigantes (GCCG) es una lesión benigna intraósea de los maxilares. Tradicionalmente, la cirugía es el tratamiento más utilizado para este tipo de patología, sin embargo, en los últimos años se ha propuesto el uso de inyecciones intralesionales de corticoesteroides como alternativa conservadora. El objetivo de este estudio fue realizar una revisión bibliográfica de los casos tratados con corticoesteroides. Para esto, se utilizó la plataforma de PubMed y Google Scholar para buscar artículos publicados entre 1994 y el 2020, relacionados al GCCG y su tratamiento con corticoesteroides. Se encontraron 28 artículos y un resumen con 61 pacientes en total; en la mayoría de los casos se utilizaron inyecciones intralesionales semanales de acetonido de triamcinolona con anestésico durante 6 semanas, aunque se reportaron variantes del protocolo. De los 61 casos, 38 tuvieron una resolución completa y en los demás casos fue necesario realizar tratamiento quirúrgico adicional. Con base en lo anterior, parece que el uso de inyecciones intralesionales de triamcinolona tiene un efecto positivo en el tratamiento del GCCG al permitir una resolución completa de la lesión o una disminución en su tamaño, de manera que la cirugía posterior sea más conservadora.Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws. Traditionally, surgery is the most used treatment for this type of pathology, however, in recent years the use of intralesional corticosteroids injections has been proposed as a conservative alternative. The aim of this study is to carry out a bibliographic review of the cases treated with corticosteroids. The author used PubMed and Google Scholar platforms were used to search for articles published between 1994 and 2020, related to CGCG and its treatment with corticosteroids. The results of this research were 28 articles and one abstract were found with 61 patients in total; in most cases, weekly intralesional injections of triamcinolone acetonide with anesthetic were used for 6 weeks, although protocol variants were reported. Of the 61 cases, 38 had complete resolution while the other cases required additional surgical treatment. From this, it seems that the use of intralesional triamcinolone injections have a positive effect in the treatment of CGCG by allowing a complete resolution of the lesion or a decrease in its size, so that subsequent surgery is more conservative

Sarcoma de Kaposi, importancia de su diagnóstico para un correcto tratamiento.

El Sarcoma de Kaposi es una neoplasia vascular poco frecuente, descrita por Moritz Kaposi en 1872.Se desarrolla comúnmente de las células endoteliales con evidencia de origen linfático también. Se han descrito 4 formas:• Clásica.• Endémica.• Asociada a iatrogenia por inmunosupresión.• Asociada a SIDA.Esta última tiene una incidencia de 70% en pacientes VIH+ siendo el paladar duro, la lengua y la encía los lugares con más frecuencia de aparición. En el 22% de los casos, la cavidad oral es el lugar de origen de esta lesión, causando movilidad dental, sangrado y dolor

Tratamiento conservador del granuloma central de células gigantes: A propósito de un caso.

El granuloma central de células gigantes (GCCG) es una lesión osteolítica benigna exclusiva de los maxilares, representa el 10% de todas las lesiones benignas de estos. Se presenta más frecuentemente en niños y adultos jóvenes (<30 años) y con mayor proporción en mandíbula que en maxilar (2:1). Puede presentar un comportamiento agresivo caracterizado por inflamación, dolor, crecimiento rápido, perforación de la cortical, desplazamiento de órganos dentarios y reabsorción radicular.Existen diferentes métodos de tratamientos, que van desde un curetaje hasta una resección en bloque, siendo estos los más agresivos. Por otra parte, existe evidencia sobre tratamientos conservadores como la infiltración de corticoesteroides intralesional, la cual ha demostrado excelentes resultados como tratamiento, basado en la naturaleza inflamatoria de la lesión

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: A subgroup analysis of the ARISTOTLE trial

Background: In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy and safety of apixaban compared with warfarin in prespecified subgroups of patients with and without previous stroke or TIA. Methods: Between Dec 19, 2006, and April 2, 2010, patients were enrolled in the ARISTOTLE trial at 1034 clinical sites in 39 countries. 18 201 patients with AF or atrial flutter were randomly assigned to receive apixaban 5 mg twice daily or warfarin (target international normalised ratio 2·0-3·0). The median duration of follow-up was 1·8 years (IQR 1·4-2·3). The primary efficacy outcome was stroke or systemic embolism, analysed by intention to treat. The primary safety outcome was major bleeding in the on-treatment population. All participants, investigators, and sponsors were masked to treatment assignments. In this subgroup analysis, we estimated event rates and used Cox models to compare outcomes in patients with and without previous stroke or TIA. The ARISTOTLE trial is registered with ClinicalTrials.gov, number NTC00412984. Findings: Of the trial population, 3436 (19%) had a previous stroke or TIA. In the subgroup of patients with previous stroke or TIA, the rate of stroke or systemic embolism was 2·46 per 100 patient-years of follow-up in the apixaban group and 3·24 in the warfarin group (hazard ratio [HR] 0·76, 95% CI 0·56 to 1·03); in the subgroup of patients without previous stroke or TIA, the rate of stroke or systemic embolism was 1·01 per 100 patient-years of follow-up with apixaban and 1·23 with warfarin (HR 0·82, 95% CI 0·65 to 1·03; p for interaction=0·71). The absolute reduction in the rate of stroke and systemic embolism with apixaban versus warfarin was 0·77 per 100 patient-years of follow-up (95% CI -0·08 to 1·63) in patients with and 0·22 (-0·03 to 0·47) in those without previous stroke or TIA. The difference in major bleeding with apixaban compared with warfarin was 1·07 per 100 patient-years (95% CI 0·09-2·04) in patients with and 0·93 (0·54-1·32) in those without previous stroke or TIA. Interpretation: The effects of apixaban versus warfarin were consistent in patients with AF with and without previous stroke or TIA. Owing to the higher risk of these outcomes in patients with previous stroke or TIA, the absolute benefits of apixaban might be greater in this population. Funding: Bristol-Myers Squibb and Pfizer. © 2012 Elsevier Ltd

Apixaban versus warfarin in patients with atrial fibrillation

BACKGROUND: Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin. METHODS: In this randomized, double-blind trial, we compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause. RESULTS: The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio with apixaban, 0.79; 95% confidence interval [CI], 0.66 to 0.95; P<0.001 for noninferiority; P = 0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; 95% CI, 0.60 to 0.80; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; 95% CI, 0.80 to 0.99; P = 0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; 95% CI, 0.74 to 1.13; P = 0.42). CONCLUSIONS: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. Copyright © 2011 Massachusetts Medical Society. All rights reserved